Mediterranean diet, physical activity, and family characteristics associated with cognitive performance in Italian primary school children: analysis of the I-MOVE project

Is higher adherence to the mediterranean diet associated with greater academic performance in children and adolescents? A systematic review and meta-analysis

OBJECTIVE

The aim of the present study was to synthesize the available evidence from the relationship between adherence to the Mediterranean diet (MedDiet) and academic performance in children and adolescents.

METHODS

A systematic review and meta-analysis was conducted, which adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Four electronic databases (PubMed, Scopus, Web of Science, and the Cochrane Library) were examined from inception to April 8th, 2024.

RESULTS

Eighteen studies were included in the current systematic review and sixteen in the meta-analysis. The relationship between adherence to the MedDiet and academic performance among children and adolescents was statistically significant (Pearson's correlation coefficient [r] = 0.17, 95% confidence interval [CI]: 0.14 to 0.21, p < 0.001; inconsistency index [I2] = 56.7%). The influence analysis revealed that removing individual studies one at a time did not result in any changes to the overall results (p < 0.05 in all cases).

CONCLUSIONS

A higher adherence to the MedDiet could play a relevant role in academic performance among children and adolescents.

Meeting the 24-h movement recommendations and its relationship with Mediterranean dietary patterns in early childhood: the SENDO project

The aim of this study was twofold: (1) to assess the association between meeting all three 24-h movement recommendations and adherence to the Mediterranean diet (MedDiet) in early childhood and (2) to examine whether participants who meet all three 24-h movement recommendations have greater adherence to the individual MedDiet foods/components than those who do not meet these recommendations. A cross-sectional study was conducted using a sample of 822 participants from the Seguimiento del Niño para un Desarrollo Óptimo (SENDO) project (Pamplona, Spain). Physical activity was assessed through a questionnaire that covered 17 different types of activities. Screen time was assessed by averaging the daily hours spent on activities such as watching TV, using a computer, or playing video games. Sleep duration was determined by taking the average of sleep durations during both weekdays and weekends. Adherence to the MedDiet was evaluated using the Mediterranean Diet Quality Index in children and adolescents (KIDMED). Greater odds of having an optimal adherence to the MedDiet were found for participants meeting all three 24-h movement recommendations (odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.33-2.87, p = 0.001) in comparison with their counterparts not meeting these recommendations. Specifically, significant differences were found for "fruit or fruit juice every day" (p = 0.012), "second fruit every day" (p = 0.001), and "fresh or cooked vegetables regularly once a day" (p = 0.018) in relation to meeting all three 24-h movement recommendation status.    Conclusions: This study provides further evidence of the potential importance of meeting all three 24-h movement recommendations to adopt a healthier eating pattern. What is Known: • Only a limited number of studies have investigated the joint connection between the 24-h movement recommendations and dietary habits. • Integrating the 24-h movement recommendations with dietary recommendations could potentially yield greater effectiveness compared to promoting these recommendations independently within public health strategies. What is New: • This is the first study in assessing the relationship between 24-h movement recommendations and adherence to the Mediterranean diet in early childhood. • These findings provide further evidence of the potential importance of meeting all three 24-h movement recommendations to adopt a healthier eating pattern.

Adolescents with a Favorable Mediterranean-Style-Based Pattern Show Higher Cognitive and Academic Achievement: A Cluster Analysis-The Cogni-Action Project

A Mediterranean diet (MedDiet) has emerged as a crucial dietary choice, not only in attenuating various adolescents' metabolic health issues but it has also been associated with improved cognitive and academic achievement. However, few studies have established patterns of food consumption linked to both cognitive and academic achievement in adolescents living in a developing country with non-Mediterranean-based food. Methods: This cross-sectional study included 1296 Chilean adolescents (50% girls) aged 10-14 years. The MedDiet Quality Index was used to assess adherence to the MedDiet in children and adolescents. Through cluster analysis, four distinct dietary patterns were identified: Western diet (WD = 4.3%); low fruit and vegetables, high-sugar diet (LFV-HSD = 28.2%); low fruit and vegetables, low-sugar diet (LFV-LSD = 42.2%); and the MedDiet (25.3%). A mixed-model analysis was conducted to compare these clusters and their relationships with cognitive and academic achievements. Principal component analysis was performed to identify four primary cognitive domains: working memory, cognitive flexibility, inhibitory control, and fluid reasoning. Academic achievement was determined with five school subjects (Language, English, Mathematics, Science, and History) and included the Academic-PISA score derived from the mean scores in Language, Mathematics, and Science. Results: A marked difference was observed between the four clusters, which was mainly related to the consumption of sugar, ultra-processed foods, fruits, and vegetables. According to cognitive performance, the MedDiet group showed higher performance across all domains than the LFV-HSD, LFV-LSD, and WD groups. Regarding academic achievement, the WD underperformed in all analyses compared to the other groups, while the MedDiet was the unique profile that achieved a positive difference in all academic subjects compared to the WD and LFV-HSD groups (p < 0.05). Conclusions: These findings suggest that higher adherence to Mediterranean-style-based patterns and better food quality choices are associated with improved cognitive and academic achievements.

Adherence to the Mediterranean Diet in Children and Adolescents and Association with Multiple Outcomes: An Umbrella Review

The Mediterranean Diet (MD) has been linked to numerous health benefits. This umbrella review aims to synthesize evidence from systematic reviews on the MD's impact on children and adolescents aged 6 to 19 years. Following Joanna Briggs Institute guidelines, we included 11 systematic reviews focusing on the MD's effects on health outcomes, such as asthma, anthropometric measures, physical fitness, and inflammatory markers. The results indicate a protective role of the MD against childhood asthma due to its antioxidant-rich components. However, evidence for its impact on allergic conditions like rhinitis and eczema is inconclusive. Findings regarding anthropometric outcomes, particularly BMI, are limited and inconsistent. A positive correlation was observed between MD adherence and increased physical activity, improved physical fitness, quality of life, and reduced sedentary behavior. Additionally, the MD showed an inverse relationship with pro-inflammatory biomarkers, suggesting anti-inflammatory benefits. The inconsistency in BMI findings and the potential anti-inflammatory properties of the MD warrant further longitudinal research. Future studies should explore the MD's impact on cognitive functions, academic performance, and mental health in this age group, highlighting the significance of establishing healthy eating habits early in life.

Physical Activity and Cognitive Functioning

Neuroscience applied to motor activity is a growing area that aims to understand the effects of motor activity on the structures and functions of the Central Nervous System. Attention has been paid to this multidisciplinary field of investigation by the scientific community both because it is of great importance in the treatment of many chronic diseases and because of its potential applications in the Movement Sciences. Motor activity during a developmental age is, in fact, an indispensable tool for the physical and mental growth of children, both able-bodied and disabled. Through movement, individuals can improve their physical efficiency and promote their own better health, establish relationships with the environment and others, express themselves and their emotions, form their identity and develop cognitive processes. This literature review aims, therefore, to highlight how an adequate practice of motor activity offers extraordinary possibilities for everyone in relation to learning, from the perspective of an integral development of the person, and, consequently, can raise the awareness of those involved in the training and growth, especially the youngest, towards the educational value of motor and sports activities. According to this review, and in line with the modern neuroscientific approach toward the relationships between motor activities and cognitive functions, it is possible to claim that hypokinesia tends to inhibit learning. Therefore, it now seems more topical than ever to draw attention to the need to introduce working proposals that integrate brain-based motor activity programs into the school curriculum.

Factors associated with Mediterranean diet adherence in a sample of high socio-economic status children from southern Spain

OBJECTIVE

The present study examined the association of BMI, fat mass, physical activity engagement (PA), maximal oxygen consumption (VO2max), screen time and academic performance (AP) with Mediterranean diet (MD) adherence in a sample of high socio-economic status (SES) children.

DESIGN

A non-randomised design was used. A multilinear regression model was developed using backward elimination. Analysis included variables pertaining to age, BMI, VO2max, fat percentage, AP, PA engagement and screen time. All participants had a high SES and so this variable was not included as a predictor. Data met the assumptions required for multiple regressions in terms of linearity, homoscedasticity, normality, independence and non-multicollinearity.

SETTING

Two state and three mixed funding schools in Granada, Spain.

PARTICIPANTS

Data were collected from 244 children aged between 10 and 12 years.

RESULTS

Better AP, higher PA engagement and lower screen time were found to be predictive of MD adherence. These variables explained 22·9 % of the variance in data measuring adolescent MD adherence.

CONCLUSIONS

The present study suggests that, in addition to SES, PA, AP and screen time are important components to consider when targeting improvements in MD adherence in children. It is, therefore, concluded that interventions targeting improvements in PA, AP and screen time are needed to promote MD adherence in children, regardless of SES.

Lifestyle Behaviours, Self-Esteem and Academic Performance in Primary Education Students-A Structural Equation Model According to Sex and School Type

(1) Background: The present study aimed to examine the relationship between physical activity (PA), screen time (ST), maximal oxygen uptake (VO2max), Mediterranean diet (MD) adherence, self-esteem (SE) and academic performance (AP) in primary education students. In order to address this aim, an explanatory model was developed to examine the existing relationships between PA, ST, VO2max, MD adherence, SE and AP. Further, the proposed structural model was examined via multi-group analysis as a function of sex and school type. (2) Methods: A non-experimental, descriptive, comparative and cross-sectional study was designed with a total sample of 269 Spanish students (11.29 ± 0.62). Validated questionnaires were administered to collect data on study variables. (3) Results: Relative to boys, girls reported better academic grades and showed a stronger positive relationship between MD adherence and AP, MD adherence and PA, and VO2max and SE. Likewise, girls showed a stronger negative relationship between ST and VO2max, and ST and MD adherence. At the same time, mixed funding school (MFS) students reported higher PA engagement than state school (SS) students. However, SS students reported better MD adherence, ST and AP than MFS students. Further, a stronger positive relationship was found in SS students between MD adherence or VO2max and SE than in MFS students. Also, within the former group, ST was more negatively related to MD adherence and VO2max. (4) Conclusions: Scientific and educational communities must develop future strategies that consider potential determinants in order to target more desirable outcomes.

Health-Related Quality of Life in Childhood and Adolescence: The Interrelation with Level of Adherence to Mediterranean Diet and Dietary Trajectories: Highlights from the DIATROFI Program (2021-2022)

Children's dietary habits can have a key role in contributing to an improvement in their Health-Related Quality of Life (HRQoL). This study aims to assess the connection between Mediterranean diet adherence and HRQoL in a sample of Greek students, utilizing data from the DIATROFI program. The parents of 3774 students (mean age 7.8 (2.6) years) reported their children's HRQoL and level of adherence to the Mediterranean dietary pattern at the beginning and end of the 2021-2022 school year. At baseline, most students' adherence was characterized as moderate (55.2%) or high (25.1%). Students with moderate or high adherence tο the Mediterranean diet were less likely to report a total HRQoL below the median at baseline (OR = 0.56, 95%CI = 0.44, 0.70), along with all its dimensions (physical, emotional, social, and school functions). A one-unit improvement in KIDMED score _{(beginning-end of schoolyear)} was associated with the likelihood of an improvement in total HRQoL _{(beginning-end of schoolyear)} (OR = 1.09, 95%CI = 1.02, 1.17), emotional (OR = 1.09, 95%CI = 1.02, 1.17), and social functions (OR = 1.13, 95%CI = 1.05, 1.22), but not with physical and school functions. The health benefits of the Mediterranean diet in children may not be limited to disease prevention but also extend to their overall wellbeing.